Imaging of sports injuries of the upper extremity in children

Magnetic resonance imaging of elbow injuries in children

Evaluating elbow injuries is challenging because of the complex anatomy of the joint. In children, injury patterns depend on the sports-specific mechanism as well as the stage of skeletal maturity. This article reviews the anatomy of the elbow and common injury patterns seen in children, with an emphasis on MRI and the throwing athlete. Imaging pitfalls specific to children are described.

Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging

Pediatric musculoskeletal system is particularly prone to traumatic and sports-related injuries, both acute and chronic, i.e., overuse injuries, because of inherent conditions of weakness, such as the open physis, representing the weakest aspect within the bone, the ligamentous supports and changing biomechanics. Being aware that a quick diagnosis is essential to preserve the good functionality of the limb involved, it is mandatory for the radiologist to recognize the most common patterns of these injuries, identifying those requiring a prompt surgery, as well as be confident with the technique performed, and be supported by an important background experience and knowledge skills.

Overuse injuries in children

There has been a substantial increase in the number of children participating in organized competitive sports, which has led to a surge in the number of both acute and overuse injuries. To prevent further complications such as limb deformity and disability, radiologists must be familiar with typical overuse injury patterns in children. Traction apophysitis, chronic physeal injury, and stress fractures are the principal overuse injuries. This article reviews overuse injuries in children with an emphasis on the role of magnetic resonance imaging in diagnosis, prognosis, and treatment.

In vivo pediatric shoulder muscle volumes and their relationship to 3D strength

In the pediatric shoulder, injury and pathology can disrupt the muscle force balance, resulting in severe functional losses. As little data exists pertaining to in vivo pediatric shoulder muscle function, musculoskeletal data are crucially needed to advance the treatment of pediatric shoulder pathology/injury. Therefore, the purpose of this study was to develop a pediatric database of in vivo volumes for the major shoulder muscles and correlate these volumes with maximum isometric flexion/extension, internal/external rotation, and abduction/adduction joint moments. A methodology was developed to derive 3D shoulder muscle volumes and to divide the deltoid into sub-units with unique torque producing capabilities, based on segmentation of three-dimensional magnetic resonance images. Eleven typically developing children/adolescents (4F/7M, 12.0 ± 3.2 years, 150.8 ± 16.7 cm, 49.2 ± 16.4 kg) participated. Correlation and regression analyses were used to evaluate the relationship between volume and maximum, voluntary, isometric joint torques. The deltoid demonstrated the largest (30.4 ± 1.2%) and the supraspinatus the smallest (4.8 ± 0.5%) percent of the total summed volume of all six muscles evaluated. The anterior and posterior deltoid sections were 43.4 ± 3.9% and 56.6 ± 3.9% of the total deltoid volume. The percent volumes were highly consistent across subjects. Individual muscle volumes demonstrated moderate-high correlations with torque values (0.70-0.94, p<0.001). This study presents a comprehensive database documenting normative pediatric shoulder muscle volume. Using these data a clear relationship between shoulder volume and the torques they produce was established in all three rotational degrees-of-freedom. This study furthers the understanding of shoulder muscle function and serves as a foundation for evaluating shoulder injury/pathology in the pediatric/adolescent population.

Medial elbow injury in young throwing athletes

This report reviews the anatomy, overhead throwing biomechanics, injury mechanism and incidence, physical examination and diagnosis, diagnostic imaging and conservative treatment of medial elbow injuries in young throwing athletes. Based on the information a clinical management decision-making algorithm is presented.

[Carpal injuries in children]

Carpal injuries in children are uncommon. Radiographic diagnosis can be difficult because of late ossification of carpal bones. Scaphoid fracture occurs in 3% of hand and wrist fractures. Fractures in the distal third or at the waist are the most frequent fracture sites. In case of clinical and X-rays presumption, CT-scan and MRI often diagnose scaphoid fractures. Orthopaedic treatment with closed cast for 8 weeks, or more for adolescents, gives a high rate of union in non-displaced or minimally-displaced fractures. Non-union is the most frequent complication. Closed cast can be the treatment of non-union in absence of humpback or DISI deformity. Other carpal bone fractures or ligament injuries of the wrist in children are uncommon and CT-scan, MRI or arthroscopy can be useful in case of clinical suspicion.

Sport injuries in the paediatric and adolescent patient: a growing problem

With an increasing number of paediatric and adolescent athletes presenting with injuries due to overuse, a greater demand is put on clinicians and radiologists to assess the specific type of injury. Repetitive forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. Intrinsic and extrinsic risk factors all play a role in the development of overuse injuries. MRI plays a key role in imaging overuse injuries due to its high potential for depicting cartilaginous and soft-tissue structures. Sport-specific biomechanics are described, since this knowledge is essential for adequate MRI assessment. An overview of several sport-related injuries is presented, based on anatomical location.

Modern imaging of the hand, wrist, and forearm

A review of the current state of the relevant diagnostic imaging technologies and methods and their clinical application in imaging common conditions of the hand, wrist, and forearm is presented. Evolving and future imaging technologies are also considered.

Imaging of sports injuries in children and adolescents

Sports injuries may be unique in childhood and adolescence due to the inherent weakness of the growing skeleton at specific sites, mainly the cartilaginous parts. Many injuries are predictable based on the known mechanism of injury encountered in certain sports. There are two distinct patterns of injury in sports; acute, and chronic or overuse. Imaging plays an important role in the diagnosis and management of these entities. Radiologists should be familiar with the advantages and limitations of the various imaging modalities when evaluating the injured young athlete. The present review focuses on the radiological findings and appropriate imaging approach in injuries that are typically or most commonly encountered in the skeletally immature athletes.